Rapid-Cycling: Research is ME-Search

One of the joys of doing posts under my own name and as the “Ask the Expert Patient” here at BipolarConnect is the connections I make with people. It usually starts out in the nature of a message in a bottle. Next thing the bottles are whizzing along in both directions.

Recently, Country Girl responded to an Ask the Expert Patient post of mine. I responded in turn with an Ask the Expert Patient article, which in turn generated a gracious reply. Amongst other things, she wrote:

“What you said about the extreme rapid-cycling is ME. How you picked up on that is amazing. I had never heard of the title you gave that before. Trust me, this type A personality will be researching it even more to see if the meds I’m on are what will help or not.”

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Rapid cycling is an extremely important topic, so feel free, everyone, to listen in on the conversation:

Okay, Country Girl, you know that joke that starts with the question, “What is the shortest book ever written?”

Well, you guessed it, it’s not Heidi Klum’s “Bad-*** Nerds I Have Dated.”

In my book, “Living Well with Depression and Bipolar Disorder: What Your Doctor Doesn’t Tell You That You Need to Know,” I note that rapid-cycling represents “the true dark side of the moon for our illness.” Later on, I observe that “seminars at mental health conferences on treating rapid-cycling are as plentiful as vine tomatoes in winter.”

I’ve been attending mental health conferences since 2000, and have yet to come across a session on rapid-cycling. A quick PubMed search reveals a mere 655 articles for “bipolar rapid cycling.” This contrasts with 23,124 for “bipolar mania.” The only books listed on Amazon with cycling in the title have to do with the sport of Lance Armstrong.

The one study approaching a clinical drug trial on rapid-cycling is particularly revealing for its high drop-out rates: 76 percent for the first phase of the study, 78 percent for the second phase. Of 254 patients entering the study, only 13 lasted the full 20 months.

Is rapid-cycling truly that difficult to treat? According to Goodwin and Jamison in their authoritative “Manic-Depressive Illness: Bipolar Disorder and Recurrent Depression” (2nd edition), “it appears that most rapid-cycling patients do not respond particularly well to any medication.”

Lithium used to have a bad rap for treating rapid-cycling. The good news for lithium these days is that more modern mood stabilizers are turning out to be just as bad.

What kind of phenomenon are we talking about?

The DSM lists a minimum of 4 episodes back and forth a year, which suggests a rather slower pace than rapid. Unofficially, psychiatry picks up the tempo by acknowledging “ultra-rapid” and “ultradian cycling.”

Officially, for a bipolar diagnosis, there is a two-week time minimum for depressive episodes, one week for mania, and four days for hypomania. That completely leaves out those of us who get whiplashed up and down in a matter of hours and minutes. Technically, this group fails to meet the DSM criteria for bipolar. Huh?

See what you’re up against, Country Girl? You’re chafing at the bit to research the topic, and the research - much less psychiatric horse sense - simply isn’t there.

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Common sense suggests you need a mood stabilizer, but which mood stabilizer is a matter of conjecture. The treatment guidelines such as the one put out in 2002 by the American Psychiatric Association are very vague on the topic, but they are uniformly unequivocal in stating that antidepressants should not be used. Antidepressants run a high risk of speeding up cycles. Mood stabilizers, imperfect as they are for the purpose, at least offer the promise of slowing down the cycle.

We also know that rapid-cyclers appear to be extremely sensitive to their environment, and this would include stress. Thus, a key to slowing down your cycle is slowing down your world.

So here’s where you need to apply your research, Country Girl. You need to figure out those areas in your life that represent clear and present dangers to your stability, that may set you off. It may be drinking caffeine or eating high-sugar foods. It may be listening to talk radio. It may be from driving yourself too hard. It may be an unpleasant individual in your life.

Then you need to figure out ways to avoid these situations, or at least cut down on the possibility of them happening. But sh*t happens. So now you have to figure out ways to deal with the bad stuff you can’t avoid.

Obviously, figuring out the riddle wrapped in a mystery inside an enigma that is you is going to be a difficult nut to crack. Introducing the necessary changes into your life won’t be a piece of cake, either. The good news is you will have plenty to research. Research is me-search. You are in for a very rewarding endeavor.

Finally, Country Girl, it’s a pleasure making your acquaintance. Please keep the messages in bottles coming.